While it is always important to be aware of stroke symptoms and prevention guidelines, it is even more crucial in the winter as the risk increases with cold weather and the holidays.

The American Stroke Association recently issued new guidelines on preventing a stroke ─ the fourth leading killer in the U.S.. Because the majority of strokes can be prevented with lifestyle changes, it is important to take these recommendations to heart.

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According to the experts at Northwestern Medicine, cold weather causes blood vessels to contract, which raises blood pressure and increases the risk for heart attack and stroke. Coupled with cold weather, the holiday season can cause stress hormones to rise. The double whammy of chilly weather and stress further increases the likelihood of cardiovascular events.

Global studies have confirmed that the incidence of strokes increase in winter, says the American Heart Association (AHA). A German study, for example, found that for every 2.9- degree Celsius drop in temperature over 24 hours, strokes increased by 11%, and at even higher rates for those at high risk.

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Another study from Brazil found that falling temperatures may increase the number of deaths from stroke.

Staying inside all winter to prevent an increased risk of stroke isn’t practical or even recommended, so it is important to follow these tips to help protect yourself:

• Dress for the weather. Wear layers, especially hats, gloves and heavy socks.

• Come inside often. If you are outside for an extended period, take breaks and come indoors.

• Avoid excess alcohol. Alcohol makes you feel warmer than you are and can be particularly dangerous if you are drinking out in the cold. 

• Don’t overdo shoveling! According to Everyday Health, snow shoveling has been linked to a spike in cardiovascular events soon after major snowstorms. A major study looking at snow removal-related medical emergencies treated in the U.S. between 1990 and 2006 identified about 11,500 shoveling injuries over the 17-year span — cardiovascular events accounted for half of the hospitalizations and 100 percent of the deaths. Ask your doctor if it is safe for you to shovel at all.

• Get help. If you have symptoms of a heart condition, don’t wait to get help, even on holidays.

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According to The Washington Post, about 80% of strokes are preventable. So, take extra care as the weather gets nippier to:

• Watch your numbers. Manage health issues such as high blood pressure and reduce sodium intake to less than 1,500 milligrams daily. Maintain a healthy weight and exercise regularly. Talk to your doctor about your risk for atrial fibrillation, a condition characterized by an abnormal heart rhythm that affects about 10% of people over the age of 80. People with A-Fib are five times more likely to have a stroke.

• Eat a Mediterranean diet. Experts say that following a Mediterranean diet that is rich in whole grains, fruits, vegetables and legumes, plus heart-healthy fats such as olive oil and lots of fish, can reduce your risk of a cardiovascular event like heart attack or stroke by as much as 26% compared to those who follow a low-fat diet.

• Avoid pollutants. A review published in the journal Stroke said that even short-term exposure to air pollution may raise stroke risk. Check the air quality where you live by visiting AirNow.gov. On days with high pollution, limit your time outdoors.

• Control stress. One study found that one stressful life event increased the risk of stroke by 17%, while two raised the risk to 31%.

Stroke experts have coined the acronym FAST to help determine if you or a loved one are having a stroke. F for face, A for arm, S for speech, and T for time. Call 911 right away if you suspect a stroke.